Abuse of the Hospital A & E

Frank the tank

nicensleazy wrote:

A friend of mine told me that the police are often called to Hospital A & E depts where the staff have been assaulted by the public!

I believe, statistically an A&E nurse is more likely to be assaulted doing their job than a police officer is.

The majority of my personal experience of A&E was on Sunday morning/afternoon and most people were wearing football shirts. They gave up calling peoples names out it was a case of NUMBER 10, BLACK AND BLUE STRIPES.

nicensleazy

Well, I would of visited at dentist if it was indeed a dental issue. But when the baby has a hole below her lower lip, I guess A & E would be the best place for stitches!

Stick8267

As a consultant running an inner city A&E I can tell you the whole thing is much more complicated.

Nobody comes to the A&E for fun unless they've got significant mental health problems and then, in truth, they are ill. Emergencies are, like beauty, in the eye of the beholder and they genuinely believe their problem to be real and significant. Also many parents bringing well children are simply scared and need reassurance. The real problem is the break up of the extended family and local community. Time was if your child had a rash you would have a chat with Aunty round the corner who would tell you everything was ok and you'd be fine.

As for the drunks. Alcoholics have serious mental and physical health issues and I see no reason to discriminate against them. People who are just drunk after a good night out and end up injured are not really any different to the cyclist who chooses to blast it down a descent and hits a pothole. Both quite avoidable and most of us fit the 'there but for the grace of God' test for both examples.

Btw to reassure gbs it's nowhere near as dangerous as people think. If you treat people with professionalism and respect they're rarely a problem. In fifteen years I've never had a significant issue and security is good.

As I tell my trainees, there's no such thing as an inappropriate attender merely an inappropriate response!

Frank the tank

Stick8267 wrote:

As a consultant running an inner city A&E I can tell you the whole thing is much more complicated.

Nobody comes to the A&E for fun unless they've got significant mental health problems and then, in truth, they are ill. Emergencies are, like beauty, in the eye of the beholder and they genuinely believe their problem to be real and significant. Also many parents bringing well children are simply scared and need reassurance. The real problem is the break up of the extended family and local community. Time was if your child had a rash you would have a chat with Aunty round the corner who would tell you everything was ok and you'd be fine.

As for the drunks. Alcoholics have serious mental and physical health issues and I see no reason to discriminate against them. People who are just drunk after a good night out and end up injured are not really any different to the cyclist who chooses to blast it down a descent and hits a pothole. Both quite avoidable and most of us fit the 'there but for the grace of God' test for both examples.

Btw to reassure gbs it's nowhere near as dangerous as people think. If you treat people with professionalism and respect they're rarely a problem. In fifteen years I've never had a significant issue and security is good.

As I tell my trainees, there's no such thing as an inappropriate attender merely an inappropriate response!

very enlightening post to the likes of myself. I've always felt people who are aggresive toward hospital staff in A&E should just be "turfed out" .

mroli

Thank you for the kind words and thoughts people. We have been surprised and comforted by the extent of people's empathy - it does not take the pain away, but where we think the world is wholly bad, it does show that there is good.

M

www.georgesfoundation.org

nwallace

When I put my teeth through my bottom lip it was a job for the local doctor and a couple of paper stitches.

When I was admitted with Appendicits the porter told me to sit in a chair and wouldn't let me walk anywhere.

And when the dog put it's teeth through my arm that was an A&E job.

Not exactly sure how mum decided that teeth through lip was doctor but dog bit was hospital, possibly relates to the amount of blood, but also have the advantage of some of the neighbours being medically trained.

Something like a broken arm could probably normally be dealt with by a fast response car with first responder, but of course patients complain about them because they aren't ambulances...

softlad

nwallace wrote:

Something like a broken arm could probably normally be dealt with by a fast response car with first responder, but of course patients complain about them because they aren't ambulances...

does nobody remember the days when ambulances were simply 'delivery' vans...?? These days, they are all trained paramedics - but that wasn't always the case...

cooldad

Mroli - my sympathies - don't know how I'd deal with something like that.

My son was hit by a car on his way home from school on Friday. (turned right across his lane) Not too bad but enough to snap his carbon steerer in half and smash the car's headlight and dent the bonnet with his knee.
Paramedics checked him out - couple of bruises but ok - they bounce at his age. Back on the (one of the spares) bike on Saturday.
Idiot women in the car insisted on being taken away to A&E in an ambulance, after an hour or two of hysterics on the side of the road - SHE was suffering from shock!!!!

Now that's abuse.

shouldbeinbed

cooldad wrote:

Mroli - my sympathies - don't know how I'd deal with something like that.

My son was hit by a car on his way home from school on Friday. (turned right across his lane) Not too bad but enough to snap his carbon steerer in half and smash the car's headlight and dent the bonnet with his knee.
Paramedics checked him out - couple of bruises but ok - they bounce at his age. Back on the (one of the spares) bike on Saturday.
Idiot women in the car insisted on being taken away to A&E in an ambulance, after an hour or two of hysterics on the side of the road - SHE was suffering from shock!!!!

Now that's abuse.

Thats thinking ahead and getting her retaiation in first. any repercussions from it or insurance claim from you, shes the shocked hospital attendee and its all your sons fault,

Mroli, deepest sympathies, I can't imagine anything worse to go through.

chriskempton

Stick8267 wrote:

As for the drunks. Alcoholics have serious mental and physical health issues and I see no reason to discriminate against them. People who are just drunk after a good night out and end up injured are not really any different to the cyclist who chooses to blast it down a descent and hits a pothole. Both quite avoidable and most of us fit the 'there but for the grace of God' test for both examples.

And furthermore, what is a "drunk?".

I've been in A&E on more than one occasion with friends who've been assaulted whilst on a night out. As an innocent victim of an unprovoked assault, should someone be held responsible for the assailant's actions and have to pay for treatment? I would say absolutely not.

How would A&E staff make the call if that was the case? Of course everyone will claim to be an innocent victim, and the reality is that the police never get to the bottom of the vast majority of incidents.

1footedninja

get rid of more of the middle management , those bumbling about in cushty well paid jobs, the ones who seem to be taking eternal sabbaticals, then when they do go into work they just get a lacky to print out a few pie charts for them and some stats and do a talk for 10 minutes on pure fiscal nonsense whilst all the money goes into their pockets.

give more help to those on 'the frontline'

our NHS should be something to be proud of - if we start going down the road of 'pay more for it to be in this state and such and such in a private hospital kind of way you can kiss goodbye to everything 'good' about it as it swollows itself up its own bumhole and people would rather go to a vets to get stitched up or do it themselves rambo style than down to A&E.

Mroli sorry about your loss, as someone who know 2 close friends who lost their two young boys in a tragic housefire,how that devastated them and then from this tragic loss they now have 2 boys and a girl - all I can say is - remember the good memories & keep strong in your heart mate.

Stick8267

chriskempton wrote:

Stick8267 wrote:

As for the drunks. Alcoholics have serious mental and physical health issues and I see no reason to discriminate against them. People who are just drunk after a good night out and end up injured are not really any different to the cyclist who chooses to blast it down a descent and hits a pothole. Both quite avoidable and most of us fit the 'there but for the grace of God' test for both examples.

And furthermore, what is a "drunk?".

I've been in A&E on more than one occasion with friends who've been assaulted whilst on a night out. As an innocent victim of an unprovoked assault, should someone be held responsible for the assailant's actions and have to pay for treatment? I would say absolutely not.

How would A&E staff make the call if that was the case? Of course everyone will claim to be an innocent victim, and the reality is that the police never get to the bottom of the vast majority of incidents.

What is a drunk indeed?

I (and every other A&E Doc) has seen the abusive, obnoxious patient smelling of alcohol that turns out to have had one drink and a bleed in to their brain. Impossible to reliably tell them apart from your good old fashioned Saturday night special unless you take them all very seriously.

Mroli, can I add my deepest sympathies. Words are inadequate but thoughts are priceless and with you.

softlad

Stick8267 wrote:

What is a drunk indeed?

I (and every other A&E Doc) has seen the abusive, obnoxious patient smelling of alcohol that turns out to have had one drink and a bleed in to their brain. Impossible to reliably tell them apart from your good old fashioned Saturday night special unless you take them all very seriously.

sorry I have nothing to contribute to this part of the debate - other than to say that is an extraordinarily balanced, consciencious and impressive reply...

pinkerton

Good thread.

I have the misfortune of working in the A+E of a large south london teaching hospital. A few times per shift I see patients with chronic abdominal pain/headaches/dizzyness etc turning up expecting CT scans/ultrasounds/other complex imaging and investigations, especially out of hours. A+E is not a diagnostic centre.

I often reply: "this is a department of emergeny medicine, and your problem is not an emergency.

softlad

pinkerton wrote:

I often reply: "this is a department of emergeny medicine, and your problem is not an emergency.

why would those symptoms not be regarded as emergencies...??

jedster

Our son has quite severe allergies that have required a few ambulance trips to A&E. Basically, if an attack gets severe then his throat starts to close up, we reach for the epipen (adrenaline injector) and phone 999. The advice is that once he has adrenaline, he needs to be under medical supervision.

As we have got more sensitive to the symptoms, we have sometimes been able to get them under control at an earlier stage with inhalers and oral medicine. We still tend to phone for medical advice at this point. That tends to result in a paramedic being despatched and ultimately they tend to call for an ambulance.

mroli's story is gutwrenching. I can't do anything but add my sympathy.

The one thing I would say to add to his point is that in our experience the emergency services are very understanding of parents worrying about a small child. They are very unlikely to see you as wasting their time if you have concerns about breathing, high temperatures, head injuries etc.

All that said, people do waste a lot of NHS time. That's what inevitably happens when services are free. A&E departments are pretty skillful at sorting the wheat from the chaff - "yes sir, we will take a look at your sprained ankle but at the moment it looks like you will be waiting behind all those people with more urgent conditions and any more that come in in the mean time".

Personally I think we should start charging people for visting A&E and for GP appointments just as we charge for prescriptions, eye tests and dental care. Obviously we would need concessions for people on benefits etc just as we do for all those other charges.

Spen says

"The whole raison d'etre of the NHS is that it is free at the point of delivery, or have you forgotten that?"

Clearly that is nonsense - see the examples of charges we already have. In my view the whole raison d'etre of the NHS is to provide a comprehensive umbrella of care to everyone so that no one gets untreated because they haven't got the money. We are struggling to afford the NHS (at least the range of treatment we would like to see). The best thing that we can do is to improve productivity/efficiency (and anyone who has spent any time in hospitals can see that this is a real opportunity) - making people understand that the service has a cost and that perhaps they should spend 49p on a packet of unbranded paracetemol and stay in bed rather than seek GPs advice about their cold would be a step in the right direction.

jedster

BTW, the French healthcare system is widely held up as being excellent - comprehensive, high quality and good value for money (although they spend a bit more than we do). French professionals find it amazing that we dont charge for GP appointments "but surely you just get the waiting rooms full of timewasters?"

err.....

bompington

softlad wrote:

pinkerton wrote:

I often reply: "this is a department of emergeny medicine, and your problem is not an emergency.

why would those symptoms not be regarded as emergencies...??

The clue is in the word chronic, i.e. something that has been a continuous problem for a significant length of time. In other words something that you could have made a GP appointment for any time in the last few months.

Brassknocker

jedster wrote:

Personally I think we should start charging people for visting A&E and for GP appointments just as we charge for prescriptions, eye tests and dental care. Obviously we would need concessions for people on benefits etc just as we do for all those other charges.

Spen says

"The whole raison d'etre of the NHS is that it is free at the point of delivery, or have you forgotten that?"

Clearly that is nonsense - see the examples of charges we already have. In my view the whole raison d'etre of the NHS is to provide a comprehensive umbrella of care to everyone so that no one gets untreated because they haven't got the money. We are struggling to afford the NHS (at least the range of treatment we would like to see). The best thing that we can do is to improve productivity/efficiency (and anyone who has spent any time in hospitals can see that this is a real opportunity) - making people understand that the service has a cost and that perhaps they should spend 49p on a packet of unbranded paracetemol and stay in bed rather than seek GPs advice about their cold would be a step in the right direction.

I can't really add anymore to that, I agree 100%.

alfablue

A GP visit charge will dissuade some time wasters. A GP visit charge will dissuade some people with serious and life threatening conditions that would benefit from earliest possible diagnosis. In order to prevent the latter it is necessary to tolerate the former. I think this is the correct approach.

bompington

jedster wrote:

perhaps they should spend 49p on a packet of unbranded paracetemol

The trouble for cyclists is that most would want to buy Assos paracetamol at 49p per tablet so they could get onto the forums and boast, sorry I mean moan, about how much they spent on it

I have some experience of A&E: as a cyclist (ouch), a parent, a teacher and outdoor instructor: and Mrs Bomp has rather more as she has worked in A&E for years.
A&E staff are actually human, not plaster saints, and as such they can make mistakes (mroli - deepest sympathy, and respect for the measured and unembittered way you posted about it): frequently due to exhaustion and frustration, but incompetence is hard to eliminate completely (see below). They will crack black, blue and actionable jokes about the patients with foreign objects in strange places, and the bizarre excuses about how they got there; not to mention the "frequent flyers" whose names, drug/alcohol habits, nauseating lack of personal hygiene, and attending patterns they are thoroughly familiar with. And through it all manage to keep the professional attitude that Stick8267 demonstrates - the point being that all the inappropriate attenders are people with real needs that are not being met elsewhere.

A lot of fault can be attributed vaguely to "acopia", medical slang (with a pejorative implication, so not very PC) for just not being able to cope with life; and so you could go deeper and blame general woossiness, lack of parenting skills, society, culture, Margaret Thatcher or whatever*.

The proximal cause of increased A&E attendance is almost certainly the poor out of hours service we get these days; which has its roots in the strange reluctance of doctors to go into general practice and work all hours dealing with an ever-increasing array of trivial problems at any time of day or night - hence the notorious new GP contract: the GPs' negotiators knew they had the government over a barrel due to market forces - there simply weren't enough doctors willing to do the job under the old arrangements.

We had a scare with Bomp jr last year where the local OOH service left us with a very nasty taste - he had a very unpleasant infection, we tried hard to do things properly but wound up with a long wait to see a (well known locally to be seriously incompetent) doctor who performed a perfunctory examination (she only took his pulse when Mrs B pointed out that she hadn't done it; then recorded it as 70 - it had been well over 100 for hours) and prescribed penicillin, which is what GPs do basically as a placebo.

Mrs Bomp managed not to hit her and took him straight to A&E, but still tried to avoid the insider route - resulting in a long wait until one of the consultants happened to see her and asked her what was up: less than an hour later he was in theatre having a life-threatening abscess drained.

I have no idea what that story proves, if anything at all, but if it hadn't been for the old boy network, or if we hadn't been assertive enough to doubt the initial poor treatment (medical knowledge didn't come into it, it was bleeding obvious - but you trust the experts, don't you?), then the outcome could have been a lot worse than surgery and two weeks in hospital...

*Of course we all know it's really Wiggle's fault

jedster

A GP visit charge will dissuade some time wasters. A GP visit charge will dissuade some people with serious and life threatening conditions that would benefit from earliest possible diagnosis. In order to prevent the latter it is necessary to tolerate the former. I think this is the correct approach

Very few healthcare systems in the Western world have free GP appointments (see the French example above) so I don't see how you can say they are "necessary" just because that is the way we have done it in the UK

alfablue

The fact that other healthcare systems charge fees does not make it the correct approach. Will it dissuade some very needy people from seeking timely help? Unarguably, yes. Do people give a damn? Not if it doesn't affect them.

jedster

Will it dissuade some very needy people from seeking timely help? Unarguably, yes.

Yes but tthe question is not if it will dissuade "some" but whether this downside is over compensated by freeing up resources.

As people on benfits, the retired, children, pregnant women would all be exempt from charges (as they are for other charges) - I think the number of "very needy" people being undesirably deterred should be minimal.

As I say, excellent and generous health care systems manage to operate with charges - why not the NHS?

Ands

I think Australia has an effective system. GP appointments are funded by the state healthcare system (Medicare), however, some GPs charge the patient for an appointment at the point of service, and the patient then claims the cost of the appointment back from Medicare. Other GP surgeries operate a 'bulk billing' system, whereby the cost of seeing a doctor is charged directly to Medicare and therefore the patient does not hand over any money to the GP surgery.

This gives the public two choices - if you don't want to pay and claim back, find a bulk-billing doctor; if you don't mind paying and claiming back, go to a non-bulk-billing doctor. In my experience, if you want an appointment quickly, go to a doctor and pay/claim back. Bulk-billing surgeries are always busier and you can wait days for an appointment. How many people are deterred from seeing a doctor when they don't really need to because of the extra time required to pay and then claim back the cost? If you really need to see a doctor, get yourself an appointment quickly at a surgery with low waiting times. You can got to any surgery to see a doctor - you don't have to go to the same place every time.

Medicare offices are nearly as common as post offices, so you can claim your money back very easily.

No doubt it's not a flawless system but it probably does deter some timewasters, particularly if there is no bulk-billing surgery close by.

alfablue

jedster wrote:

Will it dissuade some very needy people from seeking timely help? Unarguably, yes.

Yes but tthe question is not if it will dissuade "some" but whether this downside is over compensated by freeing up resources.

As people on benfits, the retired, children, pregnant women would all be exempt from charges (as they are for other charges) - I think the number of "very needy" people being undesirably deterred should be minimal.

As I say, excellent and generous health care systems manage to operate with charges - why not the NHS?

So the majority of people would be exempted from charges anyway (assuming that this would be similar to those who get free prescriptions). So the time wasters that are deterred will be only the relatively well off variety. Of these, the people who don't want to pay but do want to be seen will abuse A&E. Any benefit of freeing up resources may be offset by the greater costs of treating people with worse health / with diseases that have (unnecessarily) progressed further, and by the costs associated with collecting this new tax on health.

As is often the case, the "cure" would seem to be worse than the "disease"!

alfablue

Compared with the UK, Australia spends more GDP on health care, a greater % of government expenditure goes on health, yet a smaller % of health care provision is funded by the state. Like it or not, the system is less cost-effective than that in the UK, one reason will be the greater admin costs associated with all this billing.

el_presidente

In a year or two when the cuts kick in we'll be back to 10 hour waits in A&E, the non-essential cases will soon get bored with that.

Ands

alfablue wrote:

Compared with the UK, Australia spends more GDP on health care, a greater % of government expenditure goes on health, yet a smaller % of health care provision is funded by the state. Like it or not, the system is less cost-effective than that in the UK, one reason will be the greater admin costs associated with all this billing.

You've quoted figures for a healthcare system in its entirety. My post was specifically about the GP surgery system. Presumably tho, you can Google figures for that too.

And yes, there is a greater administrative cost - but some of that may be offset by reduced demand on the GP surgery system that a billable system creates.

alfablue

You are suggesting that the billing system reduces time wasters. Those with little money won't pay and won't put up with the prolonged wait for an appointment at a bulk billing service.

Meanwhile, patients pay doctors, doctors provide evidence to the state, patients claim from the state, evidence is compared, claims agreed or declined, the state refunds patients. This seems a pretty circuitous route that will have considerable costs - the only benefit of which seems to be dissuading time wasters, and also limiting easy access to those who are hard up or reluctant, even if they have genuine need . Why not have the state directly fund the GP's? Cut out pushing the money from pillar to post. Save the many administrative steps associated with this process.

Really, it amounts to long waits reduces time wasters - if that's the case there's no need to introduce a billing scheme to do this, in years gone by GP surgeries have managed to be very effective in this respect.